Essays on health and public policy

Date

2020-06-22

Authors

Beheshti, David Thomas

Journal Title

Journal ISSN

Volume Title

Publisher

Abstract

This dissertation examines the economic and health impacts of policies which affect access to useful but potentially addictive substances.

The first chapter examines how the availability of prescription opioids affects the labor market. I provide new evidence on this question by leveraging a natural experiment which sharply decreased the supply of hydrocodone, the most commonly prescribed opioid in the US, relative to other opioids. I identify the causal impact of this decrease by exploiting pre-existing variation in hydrocodone prescribing patterns to compare areas differentially exposed to the treatment over time. Areas with larger reductions in hydrocodone prescribing experienced relative improvements in labor force participation and employment. These findings suggest that policies which reduce opioid misuse may also have positive spillovers on the labor market.

The second chapter, previously published in Health Economics, examines how efforts to reduce the abuse potential of prescription opioids affect population health. In response to rising opioid overdose deaths, pharmaceutical companies have begun introducing abuse-deterrent painkillers, pills with properties that make the drug more difficult to misuse. The first such painkiller, a reformulated version of OxyContin, was released in 2010. Previous research has found no net effect on opioid mortality, with users substituting away from OxyContin toward heroin. This paper explores health effects of the reformulation beyond mortality. In particular, heroin is substantially more likely to be injected than OxyContin, increasing exposure to blood-borne diseases. Exploiting variation across states in OxyContin misuse prior to the reformulation, I find large relative increases in the spread of hepatitis B and C in states most likely to be affected by the reformulation. In aggregate, the estimates suggest that absent the reformulation we would have observed approximately 76% fewer cases of hepatitis C and 53% fewer cases of hepatitis B from 2011-2015. This finding has important implications for future policies addressing the opioid crisis.

The third chapter examines whether state-level decisions to liberalize access to medical marijuana have spillover effects on neighboring states. Previous research on medical marijuana laws (MMLs) has assumed that the effects of MMLs are only present in the states that adopt them. However, anecdotal evidence from politicians and law enforcement officials suggests that MMLs lead to increases in drug-related activity in neighboring states. In this paper I utilize a difference-in-differences strategy to test whether the effects from MMLs spill over across state lines. I present indirect evidence that MMLs do affect nearby states. Most importantly, I find a substantial reduction in opioid abuse in states which border MML states, suggesting substitution away from prescription opioids and heroin toward marijuana.

Department

Description

LCSH Subject Headings

Citation